title: Prospective comparison of palpation versus ultrasound-guided radial access for cardiac catheterization.
abstract: BACKGROUND
  Radial access is increasingly used for both diagnostic and interventional cardiac procedures. Prospective data comparing ultrasound- versus palpation-guided radial catheterization are largely lacking.
  
  
  METHODS
  In this prospective, single-center study, a total of 183 consecutive patients scheduled for transradial cardiac catheterization by an experienced interventionalist were assigned 1:1 to either palpation- or ultrasound-guided radial access. Demographic and procedure parameters were prospectively recorded.
  
  
  RESULTS
  Baseline demographic and clinical parameters did not differ significantly between the ultrasound group (n = 92) and palpation group (n = 91). The initial radial catheterization success rate (87% vs 86.8%; P=.999) and time to access (47 seconds [interquartile range (IQR), 20-90 seconds] versus 31 seconds [IQR, 20-75 seconds]; P=.179) did not differ between the ultrasound and palpation groups, respectively. Pulse quality (absent, weak, strong) was independently associated with access failure in both groups (P<.001). Obesity was associated with access failure in the palpation group (P=.005), but not in the ultrasound group (P=.544). In 3/12 cases (25%) in the ultrasound group and 2/6 cases (33%) in the palpation group, the operator was able to establish radial access using the alternative method (P=.710). If palpation-guided radial access failed, an additional ultrasound-guided attempt before crossover to femoral access was associated with a shorter overall time to access (525 seconds [IQR, 462-567 seconds] versus 744 seconds [IQR, 722-788 seconds]; P=.016).
  
  
  CONCLUSIONS
  Ultrasound-guided radial access seems to provide no substantial additional benefit over palpation-guided access alone. Attempting the alternative guiding methods to establish radial access before crossover to femoral access seems to be a reasonable approach.
authors.affiliation: Department of Angiology, University Hospital Basel Petersgraben 4, 4031 Basel, Switzerland. heiko.uthoff@usb.ch.
authors.forename: Lynn
authors.initials: L
authors.lastname: Zaremski
authors.forename: Ramon
authors.initials: R
authors.lastname: Quesada
authors.forename: Margaret
authors.initials: M
authors.lastname: Kovacs
authors.forename: Melanie
authors.initials: M
authors.lastname: Schernthaner
authors.forename: Heiko
authors.initials: H
authors.lastname: Uthoff
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006328:Cardiac Catheterization / Q000379:methods*; D003324:Coronary Artery Disease / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010173:Palpation / Q000379:methods*; D011446:Prospective Studies; D017534:Radial Artery / Q000000981:diagnostic imaging*; D015203:Reproducibility of Results; D025321:Surgery, Computer-Assisted / Q000379:methods*; D014463:Ultrasonography; D055815:Young Adult